Patience A. Afulani, MBChB, MPH, PhD | Epidemiology & Biostatistics | UCSF School of Medicine
Molly Altman, PhD, CNM, MPH | University of Washington School of Nursing

Socially-driven issues such as disrespect, abuse, and discrimination within the health care system play a significant role in how women of color experience, and therefore access, care during pregnancy, birth, and postpartum, which influences outcomes for mother and baby. Women of color have repeatedly described disrespectful care experiences, with loss of autonomy and self-determination. As we move from describing preterm birth disparities to action-based research, we need measurement tools that adequately capture the care experiences of women at most risk for preterm birth. We aim to 1) use community engaged approaches to adapt a quantitative scale to measure person-centered maternity care (PCMC) for women of color in the United States; and 2) describe the extent to which women in the study population are receiving PCMC. We will use a mixed-methods approach including qualitative interviews for developing and refining items and quantitative data for psychometric analysis

Sarah Roberts, DrPH | Advancing New Standards in Reproductive Health (ANSIRH), UCSF Bixby Center for Global Reproductive Health

Most states have enacted one or more policies targeting drug use during pregnancy. These include punitive policies, e.g. allowing civil commitment of pregnant women for drug use and mandating reporting to Child Protective Services (CPS). States have also enacted supportive policies, e.g. giving pregnant women priority in entering substance abuse treatment. These policies could influence preterm birth. Punitive policies could also have unintended consequences, such as deterring women from prenatal care and decreasing opportunities to provide other health-promoting interventions. The primary purpose of this project is to assess effects of state-level policies targeting drug use during pregnancy on preterm birth and prenatal care utilization and whether effects vary by race/ethnicity

Miriam Kuppermann, PhD, MPH | Obstetrics, Gynecology & Reproductive Science | UCSF School of Medicine

We will conduct formative research among Spanish-speaking Latina and low income English-speaking women and their providers, as the initial step in developing a decision support tool. The tool will facilitate informed, shared decision making about neonatal resuscitation among women who present to labor and delivery at periviable gestations and their health care providers. We will conduct design sessions with women who delivered infants at 22-25 weeks gestation, pregnant women between 22 and 25 weeks gestation, and health care providers involved in their care, to help us gain an understanding of periviable birth issues and decision support needs from multiple perspectives.

Fall 2018 Cycle
Sarah Roberts, DrPH | Obstetrics, Gynecology, and Reproductive Sciences | UCSF School of Medicine

Background: Evidence remains mixed about how many people use cannabis in pregnancy and what the harms of such use may be. It is clear however that cannabis use in pregnancy (CUIP) can increase the risk of low birthweight and possibly pre-term birth. Studies of CUIP rarely explore pregnant people’s reasons for and perspectives on their use.

Objectives: We explored the perspectives of pregnant cannabis users, in order to inform debates regarding policies and clinical practices on CUIP.

Methods: We recruited in cannabis dispensaries, social media, and prenatal clinics to find pregnant people who use cannabis regularly. We interviewed 33 people in May-August 2019. We analyzed interview transcripts to identify common themes across participants’ experiences with CUIP.

Results: Most participants reduced their cannabis use during pregnancy, though many continued daily use. Most were uncertain about health risks but perceived many benefits of CUIP. Most did not tell prenatal care providers they used cannabis, due to fear of being reported to Child Protective Services (CPS). Many providers did not ask about cannabis use at all; those that did delivered a mix of sometimes contradictory messages about health and legal risks. Participants perceived mandatory warning signs re: CUIP to be ineffective and stigma-inducing.

Conclusions: Even where recreational marijuana is legal, fears of CPS dissuade many people from discussing their cannabis use with providers, representing a missed opportunity for education, harm reduction, and support. Policymakers should consider that mandatory warning signs about CUIP may increase stigma and further impede quality health education on CUIP.

Hilary Seligman, MD, MAS | Departments of Medicine, and Epidemiology & Biostatistics | UCSF School of Medicine, Feeding America

Women in low-income households frequently report challenges affording enough of the healthy foods they would prefer to eat, particularly fruits and vegetables. The tension between what a limited food budget allows and the desire to eat a healthier diet is often strongest during pregnancy, when mothers most want to eat a healthy diet in order to support their developing baby.

The EatSF program allows participants to exchange vouchers for fruits and vegetables of their choice at 28 participating corner stores, farmers markets, and large grocery stores across San Francisco. With the support of PTBi-CA, we sought to determine the extent to which $10 in weekly F&V vouchers improves intake of fruits and vegetables, supports food security, and lowers preterm birth rates among low-income pregnant mothers in San Francisco. We collected surveys from 569 pregnant women from all 6 WIC locations in SF, both before starting in EatSF and after 3-6 months of participation. All of these women were enrolled in EatSF and receiving $40 per month in F&V vouchers. We also collected surveys from 106 non-pregnant women from WIC.

Results show that adding vouchers specifically for fruits and vegetables to existing WIC benefits improves the food security of low-income pregnant women, but at the current amount ($40 each month) does not increase consumption of fruits and vegetables. Improving food security is critically important due to its link to birth outcomes, but further studies are needed to determine what benefit level can support increased consumption of fruits and vegetables.

Melanie Thomas, MD, MS | Psychiatry | UCSF School of Medicine
Laura Gottlieb, MD, MPH | Family and Community Medicine | UCSF School of Medicine

Community health workers (CHWs) are an underutilized and uniquely equipped workforce to reduce longstanding disparities in preterm birth (PTB) across the U.S. The personal and public burdens of PTB are well documented, with a disproportionate share of the burden falling to families in poverty and minority communities, and social and psychological stressors play important roles.

The objectives of this study were twofold: 1. To determine feasibility and acceptability of using CHWs to conduct psychosocial screening and linkage to existing services for at-risk pregnant women. 2. To examine the effectiveness of CHW outreach in a high-risk pregnant population. The study population included patients in the safety net hospital of San Francisco county with CHWs from a nearby community-based organization. The first twelve months were devoted to training of CHWs, establishing work flow with prenatal care providers and staff, developing a Wellness Orientation to support services and assessing initial feasibility and satisfaction with interventions (Aim 1). The second twelve months of the study period were devoted to tracking the CHW intervention (Aim 2). Study participants were recruited using direct approach by CHWs in the clinic. Data collection included qualitative interviews with staff and chart review.

Clinic staff reported an overwhelmingly positive response to the inclusion of CHWs in the clinic workflow, citing enhanced relationships with patients and a crucial link to services. The CHWs connected to 40 patients in the hospital, the majority of whom were managing trauma histories and homelessness. Eighty percent of the patients followed up to receive direct services at the community organization, including language-concordant groups, classes, case management, and concrete resources such as strollers, car seats, food, and diapers. However, in the postpartum period, forty-five percent of patients were lost of follow up.

While the majority of individuals were successfully linked to supportive services through the CHW intervention, robust follow-up services in the postpartum period are needed.

Danielle Hessler, PhD | Family and Community Medicine | UCSF School of Medicine
Dayna Long, MD | UCSF Benioff Children’s Hospital Oakland

Preterm birth (PTB) is defined as an infant born before 37 weeks and is a prevalent problem in the U.S. with 1 in every 10 infants being born premature. A growing body of evidence highlights the importance of addressing social and environmental factors to prevent PTB and improve quality of life for families who experience PTB. This study uses the abbreviation “SOAR” to define the main social stressors that cause preterm birth, including (1) Social Determinants of Health (e.g., food insecurity, housing instability or homelessness), (2) areas of Adversity or experience of Adverse Childhood Events (e.g., experiencing abuse, caregiver substance use, caregiver mental health), as well as (3) areas of Resilience that can be further supported.

Pregnancy care can serve as a natural point for addressing SOAR factors for women at risk of PTB. Our study aimed to examine existing practices and standards for screening and responding to these factors in pregnancy care settings, and develop recommendations to increase screening and response to SOAR factors in Oakland and Alameda County.

Interviews were conducted with 25 providers across 10 clinic sites. Provider interviews revealed barriers to increased screening and response including understaffing, patients’ level of trust in providers, stigma related to “getting help,” and the structure of the Comprehensive Perinatal Services Program (CPSP), which is often utilized by clinics. Potential opportunities include addressing challenges in workflow and documentation, developing on-site social services, providing incentives for patient attendance to visits, as well as improved follow-up and care coordination.​